This recommendation is based on indirect evidence from studies primarily involving trauma and critically ill patients, where isotonic crystalloids (e.g. Ringer’s lactate or normal saline) were associated with similar or better outcomes compared to colloids, without the increased cost or risk of adverse events, such as anaphylaxis.

• The physiological rationale and safety profile of crystalloids support their use as the preferred first-line fluid resuscitation strategy in women with PPH. Colloids have not been shown to provide a significant clinical advantage and may pose greater risk in resource-poor settings.
• Crystalloids are widely available, inexpensive and simple to use, making them the most practical and scalable choice for volume replacement in both high-resource and low-resource settings. In contrast, colloids are more expensive, may require stricter storage conditions and are not universally accessible.
• The goal of fluid resuscitation in PPH is to stabilize circulation and maintain perfusion while definitive treatment of bleeding is underway. Isotonic crystalloids are effective for this purpose and should be administered alongside other components of the PPH treatment bundle (e.g. uterotonics, tranexamic acid, uterine massage and examination of the genital tract to identify the source of bleeding).
• Caution is needed to avoid fluid overload during resuscitation, particularly in women with pre-eclampsia or cardiac conditions. Clinical judgement and ongoing monitoring of haemodynamic status should guide the volume and rate of fluid administration